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When Billing and Credentialing Take Over: The Hidden Burden on Healthcare Practices?

Healthcare professionals across billing departments are reporting an alarming trend: insurance claim denials have become significantly more complex and difficult to resolve. One experienced biller summarized the industry-wide challenge: “We do everything in house, and you’re not wrong. I can’t speak as much for Credentialing, but the denials have been getting increasingly obfuscated since at least 2020.”

“Denied for the Stupidest Reasons”

Healthcare administrators consistently describe denial reasons that defy logic and waste countless administrative hours. One clinic manager expressed the universal frustration: “Between tracking credentialing deadlines, following up with payers, and resubmitting claims that were denied for the dumbest reasons it’s constant whack a mole.”

Small practice administrators echo this sentiment: “I manage a small mental health office with about 5 providers and it’s maddening. I’m doing it all in house by myself. We updated our tax ID last year and it has been a hot mess ever since. These insurance companies have you jumping through so many hoops to get up and credentialed with them (since we have to go through the recredentialing process for every payer we work with since we did this). And the denials for the most insane things? So frustrating.”

The Humana Denial Nightmare

Among payers, Humana generates particularly intense frustration from billing professionals. Healthcare administrators report unprecedented challenges with this insurer: “Humama is the worst for me! Denied for the stupidest reasons and you can call 5 times and get 5 different answers to what they need. It’s beyond ridiculous!! I have considered dropping them altogether. I hate it for the patients but it is so frustrating trying to get a claim paid.”

The inconsistency creates impossible situations for billing departments. When the same claim generates five different explanations from five different representatives, healthcare professionals cannot develop systematic solutions. Each call becomes a gamble, hoping to reach a representative who provides accurate information.

The “throwing money out the window” comment reflects the financial reality practices face. When claim resolution requires multiple calls with inconsistent information, practices must decide whether continued pursuit is financially viable or whether accepting the loss costs less than the administrative time required.

UnitedHealthcare: Multiple Plans, Multiplied Problems

UnitedHealthcare creates denial complexity through sheer volume of plan variations. Healthcare billers describe the operational challenge: “I am a biller, and we go through it daily with UHC. They have so many different plans and each provider has to be cred. with each one, as well as all of our clinics. It is the biggest pain in the ass.”

This complexity disproportionately impacts primary care practices that serve diverse patient populations. When patients arrive with various UHC plan cards, front desk staff must verify not just general UHC participation but specific plan enrollment—information that frequently changes without provider notification.

Credentialing Errors Creating Billing Disasters

Healthcare professionals report that credentialing mistakes create cascading billing problems that can persist for months. One biller described a common scenario: “As a biller, I have to work with our credentialing team often for certain denials and payer issues. Credentialing is one of the BIGGEST pain points of my job and I could never, ever work in a cred position full time. For example, if a payer has a provider enrolled with the incorrect specialty, we will reach out to said payer MULTIPLE times with all credentials, everything they need to get it fixed and updated. They will claim a request is submitted, give a reference number and everything, and never actually fix it”.

The Tax ID Update Catastrophe

Simple administrative changes can trigger denial crises that last months or years. Healthcare professionals describe the tax ID update nightmare: “We updated our tax ID last year and it has been a hot mess ever since. These insurance companies have you jumping through so many hoops to get up and credentialed with them (since we have to go through the recredentialing process for every payer we work with since we did this).”

Tax ID changes require complete recredentialing with every payer, essentially starting enrollment processes from scratch. During this transition period, claims may deny because some payers have updated information while others haven’t, creating unpredictable denial patterns that billers struggle to anticipate.

Practices must continue submitting claims even knowing they’ll initially deny, preserving the ability to resubmit once credentialing completes. This creates additional administrative work: tracking which claims are pending credentialing resolution, maintaining documentation for appeals, and following up systematically once enrollment finalizes.

Claims Sitting Unpaid for Weeks

Revenue disruption from denial-related delays creates serious cash flow problems. Healthcare administrators report: “We’ve had claims sit unpaid for weeks just because someone missed an update on a provider’s CAQH or a payer dropped them randomly.”

“Randomly dropped” providers represent another denial cause that seems to defy explanation. Practices discover mid-claim cycle that payers have terminated provider contracts without notification, causing all subsequent claims to deny. Resolving these situations requires identifying the termination cause, correcting underlying issues, reapplying for participation, and managing revenue loss during the reinstatement period.

The Documentation and Follow-Up Solution That Works

Healthcare professionals who successfully manage denial challenges emphasize systematic documentation and persistent follow-up. An experienced RCM director explained: “I work as a Director of RCM and consult on the side I oversee both credentialing and billing teams my background is 20+ billing and coding. It sounds like you may have some learning pains occurring here what I tell both teams is they cannot be afraid to be a squeaky wheel, ask questions and and ensure they keep detail documentation dates times who they spoke to etc. these two departments need to talk.”

Maintaining consistent follow-up, detailed documentation, and proactive communication with payers requires dedicated bandwidth that many practices simply don’t have. When administrators handle billing, credentialing, patient charges, accounts receivable, training, and general office management simultaneously, the “squeaky wheel” approach becomes unsustainable.

Virtual Denial Management Specialists: Systematic Resolution

Healthcare practices are discovering that virtual billing and denial management specialists provide the dedicated focus necessary to resolve complex denials systematically. Rather than spreading administrative attention across multiple responsibilities, practices can access specialists who focus exclusively on denial resolution, payer follow-up, and revenue recovery.

The cost structure makes dedicated denial management financially viable. Virtual billing specialists typically cost under $2,000 monthly for full-time support, compared to $4,500 base salary plus payroll costs and benefits (totaling up to $6,000 monthly) for local staff. This $4,000+ monthly savings per position allows practices to afford dedicated denial management resources that were previously economically unfeasible.

HIPAA, SOC 2, and ISO 27001 compliance ensures that virtual specialists handle patient data with enterprise-level security protections, addressing privacy concerns that practices rightfully prioritize.

Payer-Specific Expertise Development

Virtual denial management teams develop specialized knowledge of problematic payers like Humana and UnitedHealthcare. Rather than encountering these payers’ complex requirements occasionally, virtual specialists work with them daily across multiple practices, accumulating expertise in navigating their specific denial patterns and resolution processes.

When Humana representatives provide inconsistent information, experienced virtual billers recognize the pattern and escalate appropriately. They maintain records of which representatives provide accurate information versus which generate unreliable guidance, improving resolution efficiency.

Proactive CAQH Monitoring and Credentialing Support

Virtual teams prevent the “claims sitting unpaid for weeks” problem through proactive CAQH monitoring and credentialing deadline tracking. Rather than discovering missed attestations after denial patterns emerge, virtual specialists maintain systematic calendars alerting practices to upcoming CAQH deadlines, license renewals, and credential expiration dates.

When tax ID updates or practice changes require recredentialing, virtual specialists manage the complex multi-payer coordination necessary to minimize revenue disruption. They track which payers have processed updates, which are pending, and which require additional follow-up, maintaining the detailed documentation necessary for successful appeals once credentialing completes.

Stop Accepting “Denials for the Stupidest Reasons”

Healthcare professionals are discovering that persistent denial challenges don’t reflect billing department failures—they reflect the need for dedicated resources focused exclusively on systematic denial management and payer follow-up.

30-Day Denial Resolution Guarantee

✓ Virtual Denial Management Specialists – Systematic follow-up on “increasingly obfuscated” denials with detailed documentation

✓ Payer-Specific Expert Teams – Navigate Humana inconsistencies and UHC multiple-plan complexity with accumulated expertise

✓ Proactive CAQH and Credentialing Monitoring – Prevent “claims sitting unpaid for weeks” through systematic deadline tracking

Stop letting denial chaos control your cash flow. Get dedicated specialists who become the persistent “squeaky wheel” your practice needs.

HIPAA-compliant. Healthcare-specialized starting at $9.50 to $12.00. Under $2,000 monthly vs up to $6,000 local staff costs.

What Did We Learn?

1. Billing and credentialing are major operational bottlenecks — not just back-office tasks. When mishandled, they directly impact revenue flow, provider satisfaction, and patient access to care.

2. Administrative overload leads to burnout and inefficiency. Clinics spend valuable time chasing claims, updating CAQH, and resubmitting denials instead of focusing on patient outcomes.

3. Revenue loss often hides in the details. Missed credentialing renewals, outdated payer information, and manual billing errors can cost practices thousands each month.

4. Proactive management makes a difference. Regular credentialing audits, denial pattern tracking, and automated reminders for renewals can prevent most revenue leaks.

5. Outsourcing and automation are emerging solutions. Partnering with specialized RCM and credentialing teams—or using AI-driven automation—can help clinics reduce administrative strain and restore focus on patient care.

6. Integration is key. Billing and credentialing shouldn’t operate in silos. Aligning both functions under one coordinated workflow ensures faster payments and fewer disruptions.

What people are Asking?

1. What is medical billing and credentialing?
Billing ensures providers get paid for services, while credentialing verifies a provider’s qualifications with insurance payers.

2. Why are billing and credentialing so important?
They directly affect reimbursement, compliance, and a clinic’s ability to see insured patients.

3. What problems do clinics face with billing and credentialing?
Common issues include payer delays, denials, expired credentials, and manual data errors.

4. How can clinics reduce billing and credentialing burdens?
By automating renewals, tracking denials, and outsourcing to professional RCM or credentialing firms.

5. What’s the benefit of outsourcing these processes?
Outsourcing saves time, reduces errors, improves cash flow, and lets staff focus on patient care.

Disclaimer

For informational purposes only; not applicable to specific situations.
For tailored support and professional services,

please contact Staffingly, Inc. at (800) 489-5877
Email : support@staffingly.com.

About This Blog : This Blog is brought to you by Staffingly, Inc., a trusted name in healthcare outsourcing. The team of skilled healthcare specialists and content creators is dedicated to improving the quality and efficiency of healthcare services. The team passionate about sharing knowledge through insightful articles, blogs, and other educational resources.